Overview
The Oriental Insurance Happy Family Floater Diamond plan offers ₹12–20 lakh coverage with sum insured restoration, medical second opinion reimbursement, and SAARC country coverage. It has no co-payment and lifelong renewability, providing strong family protection. The Diamond and Platinum variants include maternity coverage after a 24-month waiting period, reimbursing up to 2.5% of the sum insured. Newborns are covered immediately up to the full sum insured. These features make it ideal for families seeking comprehensive health coverage with maternity and newborn benefits.
Experts' Review
Written by Nikhil Nair
Senior Writer
The Happy Family Floater Diamond plan from Oriental Insurance offers a solid coverage package with several notable features. It includes maternity benefits and newborn baby coverage, which are absent in lower-tier plans, and provides restoration of sum insured. The plan also reimburses medical second opinions and extends coverage to SAARC countries without extra premium, adding flexibility for frequent travelers.
Importantly, the policy imposes no co-payment, meaning the insurer covers the entire claim amount up to the sum insured, a significant advantage over many plans that require policyholders to share costs.
Room rent is capped at 1% and ICU coverage is limited to 2% of the sum insured per day, which is quite low and leads to high out-of-pocket expenses if higher room categories are chosen.
Disease-wise sub-limits apply on modern treatments, potentially limiting claims for specific procedures. Also, premiums for the Diamond plan are generally 20-25% higher than the Gold variant, reflecting the enhanced benefits but making it a more expensive option.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
No Restoration Benefit, which is a notable gap.
No Bonus for being healthy and not claiming insurance, which could be a drawback for some.
Your insurer doesn’t provide free health check-ups, which is a key feature.
Oriental Insurance
Key Insights
Founded
1947
Oriental Insurance was established 78 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
94% CSR, calculated as a 3-year average
Oriental Insurance settles 94% of all claims it receives demonstrating strong credibility.
Network Hospitals
4,000+
Oriental Insurance has a limited network of 4,000 hospitals, which may restrict access to cashless services for policyholders.
Complaints
7 complaints per 10,000 claims registered
Oriental Insurance maintains a low volume of complaints, reflecting strong customer satisfaction and effective service.
Features
All
Great
Good
Bad
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Room Rent
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Life Hardship Survival Benefit
Lump sum payment in the event insured is diagnosed with listed 11 critical illnesses outlined in the policy document.
Geographical Extension To SAARC Countries
Extends the base coverage for insured members to SAARC countries without charging any additional premiums for planned and emergency treatments. The insured member needs to make a written request to the insurer to avail of this benefit.
Personal Accident Cover
Paid out as a lump sum amount for Accidental Death, Total Permanent Disability, Permanent Partial Disability up to defined limit.
Waiver of Proportionate Deduction Clause
Enhances the clause of proportionate deduction of the room rent benefit by 50% or 100%.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Hormone Replacement Therapy
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 3 years.
Benign ENT disorders and surgeries (e.g. Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty)
Polycystic ovarian diseases
Surgery of hernia
Surgery of hydrocele
Non-infective Arthritis
Waiting Period
30 days Initial waiting period
3 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
No Restoration Benefit.
No Bonus for being healthy and not claiming insurance.
Your insurer doesn’t provide free health check-ups.
Doctor consultations are not covered.
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Frequently Asked Questions
Does Happy Family Floater Policy Diamond have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 1 to 3-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
- Maternity and Newborn Waiting Period: There’s a 2-year waiting period before you can make claims related to pregnancy and childbirth.
Does Happy Family Floater Policy Diamond have room rent restrictions?
Does Happy Family Floater Policy Diamond offer a restoration benefit?
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